There are many conventional electronic health record (EHR) systems. A simple clinical decision support is the simplest form of clinical decision support, which alerts against drug-drug, and drug-allergy prescribing errors. There are EHR systems having quality metrics. For example, in the United States, there are two main quality metrics in use: (1) PQRS (Physicians Quality Reporting System), which is overseen by CMS (the Centre for Medicare and Medicaid Services), and (2) HEDIS (Healthcare Effectiveness Data and Information Set), which is developed by the NCQA (National Committee for Quality Assurance). HEDIS is an initiative by NCQA to develop, collect and standardize measures of health plan performances. The data is reported publicly by NCQA. An EHR system that incorporates these measures can be classified under this category.
For example, a “quality metric” is something like “diabetic patients should have a glycohemoglobin blood test done within the past year (or more often).” An EHR system should be able to present to the clinician an alert in the individual patient record stating “this patient is a diabetic, but has not had a glycohemoglobin done within the past year—he/she is due for one.” Alternatively, the EHR system should be able to generate a report, such as a list of all patients (using the same example) who are diabetics but have not had a glycohemoglobin done within the past year.
Diagnosis support EHR systems are complex systems designed to assist doctors in diagnosing the problem. For example, given a patient with “symptom set x” and with “lab test results y,” give me the likely diagnoses, and recommended further testing to distinguish between them. Existing decision support systems with diagnosis support are complex and do not fit well with the clinical workflow. Furthermore, these conventional EHR are difficult to use and consume more time to use than paper systems.
CMS has become more stringent in regards to paying for patient health care claims. With this change, it is now required that every patient diagnosis be supported by complete notation of the existing conditions of each patient within the progress notes. Without proper notation in the correct sections of the doctor's notes for any existing diagnosis, CMS views that diagnosis as invalid/unsupported and will not provide funding for that condition. This leaves the doctor and patient with insufficient funds from CMS to pay for their true physical/mental conditions, and therefore, leaving the doctor without the financial means to provide the best care possible for their patients. Without proper documentation, there is insufficient funding to provide proper patient care.
Existing EHR systems are complex and inefficient at the point of care and doctors find it difficult to enter data into these systems. Moreover, documenting patient condition and diagnosis information is usually done after assessing the patient.
The U.S. Government has spent $5 billion and as the estimates approach $28 billion to create an EHR. The present EHR project has been scrapped and rebidding has been started. Pentagon Electronic Health Records Not Ready Until 2017 . . . At least-Defense One, 2/17/14 5-27A.
The British government has spent $16 billion on an EHR for the United Kingdom and the project had to be scrapped. The British authorities concluded that the EHR project had to be built from the bottom up but they have not figured how to go about doing it. Scrapped national EHR program will cost UK Billions, FierceEMR, 2/7/14 5-27A.